In conclusion, we noted a high percentage of abnormal brain CT studies in ICU patients with severe COVID-19 infection. Such abnormalities were hemorrhagic in most of the cases, highly consistent across patients, and related to worse P/F ratio and higher inflammatory indexes. The superficial distribution of hemorrhagic lesions is unusual and clearly different from white matter microhemorrhages described after severe lung failure [3]. We speculate on the occurrence of a diverse mechanism in COVID-19 patients, possibly related to endothelial damage [4], resulting in impaired microcirculatory function and vascular fragility with microhemorrhages, or thrombotic microangiopathy [5], that may be supported by similar imaging findings recently reported in a small cohort of four critically ill patients [6]. The imaging picture could also be related to the occurrence of isolated cortical vein microthrombosis, considering the increased tendency to venous thrombosis in more severe COVID-19 cases. Due to the therapeutic-intensity anticoagulation common to all cases, it is not possible to make any conclusion on a possible impact of the anticoagulant therapy itself on the prevalence of brain CT hemorrhages in the studied cohort, particularly in the absence of sufficient evidence-based data on the topic at present. The association between abnormal brain CT and patients’ outcome deserves further confirmation in a larger cohort of patients.